Airway Management with Facial Fractures

I’m Ed Smith, a Sacramento Personal Injury Lawyer. Some of the most serious injuries that can occur impact the patient's ability to breathe and the most vulnerable part of the airway is the trachea in the neck. This structure can be injured in many different ways; however, one of the most often overlooked ways is via a fracture of the face. Facial fractures have the potential to compromise a patient's airway rapidly and it is important to take a look at how best to manage a patient's airway if facial fractures are suffered.

The Challenges of Facial Fractures and Airways

When a patient breathes in, the lungs expand and the increase in surface area causes a pressure decrease in the lungs. This allows air to move from the external environment into the lungs. Air will first pass through the nose or mouth before passing into the trachea. Air will travel down the trachea and split at the carina where it will travel to either the right or left lung. The lung divides into tiny airways that lead to alveoli. Air fills the alveoli and then travels into the bloodstream where it passes to the rest of the body's organs. Damage can occur in the airway along any of these divisions and compromise a patient's ability to breathe. Losing the ability to effectively oxygenate the body, particularly the brain, for even a few minutes can lead to a patient's death. One of the most vulnerable locations is the trachea, located in the face and neck, because there is little to protect the trachea from damage. While the lungs are protected against chest trauma by the ribs, there is no such protection for the trachea. When a patient suffers facial fractures in an auto accident or otherwise, fragments from the bone fractures can break off and puncture the trachea at any location along the way. All it takes is a small puncture to cause air to leak out from the trachea. This can lead to subcutaneous emphysema which can compress the esophagus or structures in the upper chest, such as the lungs. When someone has facial fractures, it can also be a challenge to intubate them. If the fractures have changed the shape of the airway, this can make it extremely challenging to get an effective intubation. Without this emergent airway, it can be overwhelming to effectively oxygenate and ventilate the patient. A paper was published that sought to discuss how to effectively manage the airway of patients with facial fractures.

Study Overview and Results

To analyze the proper placement of the tube in an intubation, medical professionals conducted a research study to look at how the various tube placements impacted patient outcomes and surgical preference. When a patient has a facial fracture, particularly one that impacts the appearance and location of their teeth, it can be challenging to figure out how and where to place the tube so that it effectively ventilates the patient while also not being in the way of the surgeon. To check this, the researchers conducted surgical procedures on close to 100 patients with these types of fractures. They placed the tube in various locations and analyzed the patient outcomes in addition to asking about the surgeon's preference for the location. The researchers found that the fastest, safest, and most positive patient outcomes occurred when the patients had the tube placed in the retromolar space, or the space just behind the molars. This allowed the surgeons to have room and space to conduct their procedures and allowed the anesthesiologists to quickly and accurately intubate the patients in preparation for surgery. The intubation sequences took, on average, just over 100 seconds. They also reported that only two patients required a repeat trip to the operating room, a significant statistic.

Where do we go from Here?

In school, medical professionals are taught how to effectively intubate and ventilate patients who are having struggles with their airway; however, taking care of someone with a compromised airway presents a number of unique challenges. Future studies should take a look at the specific types of facial fractures and whether or not one type of intubation for one type of injury may work better than for others. They should also take a look at the specific oxygenation statistics during the intubation procedure and whether or not any of the patients have any adverse problems from potential oxygen deprivation. Finally, it may be helpful for researchers to analyze the various tube sizes and figure out how large the tube has to get before it starts to obstruct the surgical field of the surgeon. Ultimately, facial fractures can present significant aesthetic issues along with the mechanical problems of facial reconstruction. Anyone who has had to undergo these expensive procedures should talk to a legal advocate about all of their options before moving forward. These procedures can be expensive and a legal professional can help someone explore all of their options for financial assistance, particularly if there has been negligence involved.

The California chapter of the Million Dollar Advocates Forum has invited me to join its prestigious membership. Our lawyers have experience with personal injury cases and have been rated as some of the top legal professionals in the country. Our lawyers have earned verdicts and undergone case settlements worth over $1 Million dollars.

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Image Attribution: The image of the facial x-ray at the top was found on Wikimedia Commons and has been printed with permission from the 3.0 version of the Creative Commons License

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